Background: Large distal pancreatic tumors may involve the transverse or splenic flexure mesocolon. R0 resection of such lesions may be extended to the mesocolon. Interruption of the arc of Riolan may be difficult to assess especially in MIS.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Malpractice claims are a regularly increasing concern in gastrointestinal surgery. The goal of this study was to compare the current status of claims in two different French-speaking communities by a retrospective descriptive study of surgeons’ experiences, from the beginning of their practice up until December 31 2014. Data included the number, the reasons, and the results of medicolegal claims and their jurisdictions. Forty-three surgeons participated in this study. Two hundred medicolegal claims were analyzed. The mean number was 5.8 per surgeon. Bariatric surgery, colorectal surgery and parietal surgery were the most exposed. Forty-six (23%) faults were noted, while no fault was pronounced in 139 (69.5%) cases. The main reasons for lodging complaints were nosocomial infections, anastomotic leaks, poor postoperative care, hollow organ perforation, peripheral neurologic complication, and insufficient preoperative information. Forty-four percent of the complaints were analyzed by the conciliation and compensation commissions and 43.5% by the High Court. In the French-speaking group, there were 13 complaints, two of which gave rise to compensation. French surgeons are highly exposed to complaints: in French law, clumsiness or technical maladdress is considered as a fault. The patient should be informed preoperatively of all possible severe risks of a medical procedure. In Belgium, complications are exceptional and are considered random therapeutic events. Adhering to the recommendations emanating from the French High Authority of Health and Learned Societies as well as accreditation issued by the same High Authority should allow to decrease the number of undesirable events related to care and malpractice.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Objectives: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per-and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. Methods: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. Results: Mean age and body mass index were respectively 39 years and 41.5kg/m(2). Ninetyone patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). Conclusions: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.

The sensory variability of carrot was investigated during three years, 2010-2012. The quality assessment was based on descriptive sensory quantitative analysis of several batches of different carrot types from two production areas. The resulting sensory space was characterised by a first axis opposing products perceived sweet to products perceived bitter, pungent with a chemical or turpentine aroma and by a second axis based on texture, with juicier products opposed to firmer products, leaving remains in the mouth after chewing. The various types of carrot are distributed throughout the sensory space. Despite the fact that location was an important factor in the expression of quality traits, the varietal choice appeared to exert a prominent effect. Model varieties have been identified: they either had plain aromatic traits and low variability of sensory traits or were perceived as aromatic or sweet, with an environmental control of these traits.

De nombreuses études cliniques ont démontré l’efficacité de la chirurgie bariatrique dans le contrôle du diabète sucré de type 2. L’enjeu est de taille, compte tenu de la constante progression de la prévalence de la maladie et ses conséquences lourdes en termes de morbidité, de mortalité et de coûts pour la santé publique. L’objectif primaire de l’étude est l’évaluation de l’efficacité des différentes techniques de chirurgie bariatrique dans le contrôle de la glycémie chez des patients diabétiques de type 2. L’objectif secondaire est l’analyse des effets de la chirurgie sur les autres comorbidités liées à l’obésité. Nous avons analysé rétrospectivement les dossiers de 96 patients diabétiques de type 2 (le critère d’inclusion étant une HbA1c supérieure ou égale à 6,5 % sans traitement ou supérieure ou égale à 6 % avec traitement) ayant bénéficié d’une intervention bariatrique de type bypass gastrique (n = 75) ou sleeve gastrectomie (n = 21) aux cliniques universitaires Saint-Luc et suivis en consultation à 4 ± 1 mois, 10 ± 1,5 mois et 18 ± 2 mois après l’intervention. Les effets de la chirurgie sur le diabète, le poids et les comorbidités ont été évalué par des Anova à mesures répétées à une voie (selon le type d’intervention), suivies de tests t pour échantillons appariés. La rémission du diabète a été définie sur base d’une HbA1c inférieure à 6,5 % en l’absence de traitement médicamenteux. Les facteurs prédictifs de rémission ont été déterminés. L’âge moyen au moment de l’intervention était de 52 ± 10 ans et 57 % des patients étaient de sexe féminin. Le poids moyen s’élevait à 119 ± 24 kg et l’indice de masse corporelle à 42,8 ± 6,8 kg/m2. L’HbA1c moyenne de départ s’élevait à 7,7 ± 1,4 %, pour une durée estimée d’évolution de la maladie à 7 ± 7 ans. Tous les patients ont bénéficié d’un suivi médical à 4 mois, 76 % à 10 mois et 41 % à 18 mois. À 18 mois, 54 % de la population était en rémission du diabète, sans différence d’efficacité entre le bypass et la sleeve (p = 0,890), avec respectivement 55 % et 52 % de rémission. L’HbA1c diminuait de 1,4 ± 1,2 % à 4 mois et de 0,3 ± 0,7 % entre 4 et 10 mois (p < 0,001), parallèlement à une diminution du recours aux traitements médicamenteux du diabète. Le jeune âge au moment de l’intervention, une courte durée d’évolution de la maladie, un faible HbA1c, une thérapie modeste avant l’intervention et une perte de poids importante à 4 mois étaient prédictifs de la rémission du diabète. En outre, l’étude met en évidence, parallèlement à la perte de poids, un effet positif sur la tension artérielle, la dyslipidémie et le syndrome d’apnées du sommeil. Globalement, aucune différence d’évolution entre les patients opérés par bypass ou par sleeve ne fut mise en évidence. Chez les patients obèses diabétiques de type 2, une rémission du diabète sucré est observée chez au moins 54 % des sujets 18 mois après une intervention bariatrique. La chirurgie diminue significativement les taux d’HbA1c ainsi que le recours aux traitements médicamenteux du diabète. Des investigations ultérieures seront nécessaires pour évaluer la durabilité de ces résultats.

Analyser les résultats à long terme des RB pour TOVB post-cholécystectomie. Depuis 1968, 122 patients consécutifs nous ont été référés pour RB immédiate, précoce (≤ 7 jours), intermédiaire (≤ 6 semaines) ou tardive (> 6 semaines) au décours d'une cholécystectomie par voie ouverte (34 %) ou laparoscopique (66 %). Parmi 17 RB primaires réalisées dans notre institution (cholécystite aiguë/chronique = 15, anomalie biliaire = 6), 14 étaient immédiates, 1 intermédiaire et 2 avec clippage définitif d'un petit canal sectoriel droit. Parmi 105 RB référées, 4 étaient précoces, 8 intermédiaires, 85 retardées, et 8 sans réparation. Les RB consistaient en une hépatico-jéjunostomie (n = 21), selon Hepp-Couinaud (n = 66), une hépatectomie droite (n = 4) ou une autre technique (n = 6). Le taux de complications postopératoires sévères était de 4,4 %, avec un décès (patient cirrhotique). Après un suivi médian de 108 mois (2–540), 9 patients (7,4 %) furent traités pour sténose biliaire secondaire, à un délai médian de 22 mois (2–234). La RB pour TOVB après cholécystectomie est sûre et efficace dans un centre tertiaire HBP mais un suivi à très long terme est recommandé pour diagnostiquer les sténoses tardives. Les TOVB en centres experts sont détectées en peropératoire et réparées immédiatement avec de bons résultats.

BACKGROUND:Optimal preoperative treatment before colorectal cancer metastases (CRCM) resection remains unclear. This study evaluated pathological responses (pR) in CRCM resected after chemotherapy alone or combined with angiogenesis or epidermal growth factor receptor (EGFR) inhibitors.METHODS:Pathological response was retrospectively evaluated on 264 resected metastases from 99 patients. The proportion of responding metastases after different preoperative treatments was reported and compared. Patient's progression-free survival (PFS) and overall survival (OS) were compared based on pR.RESULTS:The combination of anti-angiogenics with oxaliplatin-based chemotherapy resulted in more pR than when they were combined with irinotecan-based chemotherapy (80% vs 50%; P<0.001). Inversely, the combination of EGFR inhibitors with oxaliplatin-based chemotherapy seemed to induce fewer pR than when they were combined with irinotecan-based treatment (53% vs 72%; P=0.049). Overall survival at 5 years was improved for patients with a pR in all resected metastases compared with those who did not achieve a pR (68.5% vs 32.6%; P=0.023) and this response was the only factor predicting OS in a multivariate analysis.CONCLUSION:The chemotherapy partner combined with angiogenesis or EGFR inhibitors influenced pR in resected CRCM. In our exploratory analysis anti-angiogenic/oxaliplatin-based regimens and anti-EGFR/irinotecan-based regimens were associated with the highest pR. Prospective randomised trials should be performed to validate these observations.

Tomato fruit texture is one of the most critical quality traits for both the consumer and the production chain. Texture is a complex trait for which several QTL and genes were found. However, interactions between the molecular, histological, physical and biochemical components of fruit texture have been rarely investigated. In this work an integrative approach based on multiple co-inertia analysis (MCOA) was applied to point out links among the different levels: from protein to fruit, then to identify main physiological mechanisms involved in fruit texture. Three contrasted parental lines (‘Cervil’, ‘Levovil’, ‘VilB’) and three derived QTL-NILs harbouring texture QTL on chromosome 4 and 9 were analyzed. Measurements were performed at cell expansion stage, at red ripe stage and after 7-days postharvest storage at 20°C. To increase texture variability, water deficit was induced by decreasing water supply by 40% from flowering of the third truss. Three blocks of data (texture, physico-chemical traits and proteome datasets) were analysed. Results showed a common multi-scale structure obtained from the three datasets with a main contribution of texture and biochemical blocks. At all levels, MCOA outlined strong genotype discrimination, indicating that the genetic factor was the main factor of variability, in contrast with water deficit. The first common component separated the genetic background and correlated with firmness and sugar traits. The second component represented QTL effect. The percentage of the variance of the protein block taken into account to build the common structure was low. Proteins which mainly contributed to the common components at the three developmental stages were implicated in carbohydrate metabolism. Multiple co-inertia analysis provides an interesting tool to characterize complex trait such as fleshy fruit texture by integrating several levels of studies.

Carrot is one of the major vegetables, and is a basic product highly valued by regular buyers. In spite of the natural resources of the species, diversity for consumers is poor. The aim of this work was to identify consumer preferences based on appreciation of batches representative of the carrot sensory space. Ten batches were described by a trained panel using a list of 10 attributes. The same products were given to a panel of 299 consumers from 3 French cities (Avignon, Angers, and Paris). They gave a score of general appreciation and answered a questionnaire about usage and attitude. The results show that carrots are mainly characterized by the perception of bitterness, pungency and chemical flavor in opposition to the perception of sweetness. Some batches had a higher level for global aroma. Other batches were characterized by juiciness as opposed to a high level of firmness and retention in the mouth. The highest levels of consumer satisfaction were achieved with flavored, juicy and sweet carrots. Main rejected characteristics were too much bitterness and too intense chemical flavor. The segmentation study identified three groups of consumers, differing mainly by their attitude towards the product. A group representing 20% of the panel was characterized by very marked preferences for sweet and flavored products and also for interest in a high quality product.

Cluster analysis is often used to segment a panel of consumers according to their overall liking. In general, all the consumers are assigned to one of the segments even though they do not fit to the pattern of any cluster. Within the clustering of variables around latent variables (CLV) framework, we propose two new approaches to handle this problem. The first approach (“K+1” strategy) consists in explicitly identifying an additional cluster which we refer to as “noise cluster”. The second approach (“Sparse LV” strategy) computes the groups’ latent variables of the CLV method with a sparsity constraint. Both strategies were tested on the basis of two real hedonic case studies and compared to the k-means cluster analysis. They made it possible to improve the discrimination between the products within each cluster and yield homogeneous clusters of consumers for a better understanding of the main tendencies of liking.

Background Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure and is an important supportive treatment for patients with advanced head and neck cancer. Although tumor seeding has been reported in various sites, seeding at the PEG exit site is a rare complication. Methods and Results We describe a clinical case in which squamous cell carcinoma of the hypopharynx implanted at the site of PEG insertion and was successfully removed by surgery. PEG was previously placed by the pull technique. A review of the literature, discussion of the mechanism of spread, and recommendations to avoid this complication are discussed. Conclusions To avoid this rare and poor prognostic complication, the pull technique should be avoided for PEG placement in any patient with head and neck squamous cell carcinoma. An alternative method such as the push technique should be preferred. (c) 2012 Wiley Periodicals, Inc. Head Neck, 2013

Objectives: (1) To investigate whether modulation of the cannabinoid type 1 receptor (CB1R) directly regulates the production of adiponectin (ApN) and other adipokines in omental adipose tissue (OAT) of obese subjects, (2) to establish in which cellular fraction of OAT the effects of CB1R blockade take place and (3) to unravel the underlying mechanisms. Subjects and methods: OAT was obtained from 30 obese subjects (body mass index: 40.6±1.3 kg m −2 ) undergoing abdominal surgery. Primary cultures of explants or of freshly isolated adipocytes or stromal-vascular cells (SVCs) were used. Results: In OAT explants, the CB1R blocker Rimonabant upregulated ApN gene expression. mRNA abundance of omentin that exhibits insulin-sensitizing properties was upregulated as well. Conversely, mRNA levels of two pro-inflammatory cytokines, macrophage inflammatory protein (MIP)-1β and interleukin (IL)-7 were downregulated. We next examined where these effects took place within OAT. CB1R expression was similar in both cellular fractions. In isolated mature adipocytes, blockade of CB1R reproduced the increase of ApN mRNA and the decrease of IL-7 mRNA, while inducing a rise of ApN secretion into the medium. In isolated SVC, gene expression of omentin, which is restricted to this fraction, was augmented, while that of MIP-1β was diminished. Finally, we deciphered the mechanisms leading to ApN regulation by the endocannabinoid system (ES). We first established that ApN regulation was actually mediated by the CB1R: ApN gene expression was upregulated by Rimonabant and downregulated by the CB1R agonist arachidonyl-2-chloroethylamide (ACEA). Upregulation of ApN by Rimonabant was unaltered by inhibiting cAMP production. However, downregulation of ApN by ACEA was fully reversed by an inhibitor of p38 mitogen-activated protein kinase (p38MAPK) and ACEA increased p38MAPK phosphorylation. Conclusions: Blockade of CB1R attenuates the inflammatory state in both cellular fractions of OAT either by increasing ApN and omentin production or by decreasing mRNAs of MIP-1β and IL-7. ApN regulation by the ES partly involves p38MAPK.